Medical records and the human beings they contain

In Rwanda, like Cameroon, the patients carry their medical records around with them in a small “cahier” (French for “exercise book”). Whenever they are seen by a doctor, he or she makes notes in the book, writes the diagnosis, indicates lab tests to be done, and finally writes the medication prescription(s). Sometimes all of this is fit onto the same page. Although it does eliminate a lot of the paperwork I am used to from the U.S., it is very difficult to assertain a patient’s exact medical history when they’ve lost their cahier or have a different one for each health center or hospital they’ve visited. Having doctor’s notes written in two or three different languages doesn’t simplify things, either. Frequently I have paused to offer thanks for our own medical record systems at home, however cumbersome.

“Ufite Cahier?” (Do you have your medical-record-book?) is a phrase I quickly learned to ask. Some people’s cahiers arrive in a state of disaray, folded into tiny wrinkled blobs, rain-soaked and mud-stained. Other people’s cahiers, however, are treated like a precious possession, pristinely clean and with barely a wrinkle. One woman, well-known in our HIV clinic, stored her cahier inside a folded piece of paper nested in an envelope and completely enveloped by multiple layers of brightly colored cloth in a fashion that permitted her to carry it around her waist at all times. It took five minutes to unbury it from its layers of protection. Coming from a people who have close-to-nothing as far as physical possessions are concerned, I couldn’t help but be touched by this display of ownership and care. I found myself wishing I could care for her --a human being infinitely for precious and valuable than a few bits of paper-- to the same manner and degree. But then, as I find myself frequently telling my patients (invoking a knowing smile from Theogene, my translator), “I am not God. I am a doctor, but I am not God…

“Are not five sparrows sold for two pennies? Yet not one of them is forgotten by God. Indeed, the very hairs of your hair are all numbered. Don’t be afraid; you are worth more than many sparrows” ~Jesus (Luke 12:6-7)